Paediatria Croatica, Vol. 57 No. 2, 2013.
Sažetak sa skupa
DYSKINETIC CEREBRAL PALSY IN ASPHYXIATED TERM NEONATES – THE CHALLENGE TO IDENTIFY MILD LESIONS
Vlatka Mejaški Bošnjak
; Children's Hospital Zagreb, Department of Neuropediatrics, Zagreb, Croatia
Ingeborg Krageloh-Mann
; Tübingen University Children’s Hospital, Department of Child Neurology, Tübingen, Germany
Ivana Đaković
; Children's Hospital Zagreb, Department of Neuropediatrics, Zagreb, Croatia
Josip Marjanović
; Children's Hospital Zagreb, Department of Pediatric Radiology, Zagreb, Croatia
Tonći Grmoja
; Children's Hospital Zagreb, Department of Pediatric Radiology, Zagreb, Croatia
Sažetak
Dyskinetic cerebral palsy (CP) is rare (7% of all CP cases), but typically caused by hypoxic lesions of the thalami and basal ganglia in term asphyxiated neonates. This article points to the importance of good neuroimaging in dyskinetic CP following asphyxia illustrated by the example of two term born boys. The first boy was born with Apgar score 1/5 and resuscitated. Motor development was delayed, but intellectual functions were near normal. Communication problems occurred due to orofacial dyskinesia. The second boy suffered severe intrapartal asphyxia caused by placental abruption and ruptured uterus, with Apgar score 1/3, resuscitated. His motor milestones were markedly delayed, while intellectual development was normal. His school performance was disturbed by severe dysarthria. Both children, assessed at the age of 15 years, were diagnosed as dysknetic CP using Surveillance of Cerebral Palsy (SCPE) functional classification: Patient 1, GMFCS 2, BFMCS 3b; Patient 2, GMFCS 5, BMFM 5, with accompanying impairments of epilepsy and communication problems (Viking Speech Scale, 2010, level 3) in both patients. In both children, brain MRI, performed at the age of 15 years (1.5 Tesla) revealed mild but typical bilateral deep grey matter lesions involving the ventrolateral thalamus (Patients 1 and 2) and posterior putamen (Patient 2), best seen on T2 w and FLAIR images. Both children were term born with clear signs of asphyxia and hypoxic-ischemic encephalopathy and then developed dyskinetic CP with severe communication problems but near normal intellectual functions. Brain MRI of both children revealed mild but bilateral lesions in the thalami and putamen (Patient 2). In cases of asphyxiated neonates developing dyskinetic CP, quality MRI is an important diagnostic step. Lesions, although small but involving strategic domains, can cause severe motor impairment, and may be overlooked.
Ključne riječi
Hrčak ID:
105059
URI
Datum izdavanja:
25.6.2013.
Posjeta: 370 *